| Membership Application for HOUSTON AREA CONTINUITY OF CARE |
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Last Name: ___________________________ First Name:_____________________________________
Office Ph: (___)_____________ Cell Ph: ____________________________ FAX: ________________
Employer: ___________________________________________________________________________
Title:_______________________________E-mail: __________________________________________
Mailing Address: ______________________________________________________________________
Membership Directory description: (25 words or less.) Or email to: barbaralspan@gmail.com
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
Please Select One of the Following Options:
_______ Enclosed is my check for $55 - Individual Membership (NON TRANSFERABLE)
_______ Enclosed is my Company's check for $200 – Corporate Membership (WAIT LIST FOR 2010)
Name of Company______________________________________________________________________
_______________________________________________________________________________________
Name of Alternate Member: _____________________________________ ________________________
_______ Enclosed is my company's check for $125 - Group Membership
Name of Company_______________________________________________________________________
Individual Membership Benefits ($55)
1. Monthly Networking opportunity
2. Cultivate professional relationships
3. Member–only access to HACOC website
4. Exposure to industry updates and education
5. Listing in the web HACOC Directory
6. Accessibility to Discretionary Fund
7. Opportunity to display marketing materials at meetings on display table only.
8. Participation in Annual Fundraiser if (Applicable)
9. Reduced Cost for monthly meeting and lunch ($25 members / $35 non-members)
Corporate Membership offers the following advantages ($200)
1. Membership is the company, not a specific employee (more versatile.)
2. Two (2) company employees per meeting are entitled to member lunch rates ($25-member vs. $35
non-member per lunch meeting, a $10 per person per lunch savings.)
3. Corporate Sponsorship only - company will "Lunch Sponsor" at one meeting during the year and
be entitled to an "infomercial" as part of the regular program at the meeting and arrange for
program. Also included is the logo on the HACOC website and on the meeting announcement for
the month.
4. "Group Membership" entitles company to be a "Dessert Sponsor" at one chosen meeting and
display signage and brochures on the dessert table $125 Two Members>
Please return this form and check to:
Houston Area Continuity of Care
P.O. Box 301128
Houston, TX 77230-1128, or
Pay by cash or check at the next meeting.
APPLICANT SIGNATURE:
__________________________________________________________________
Consent to be listed on the website in Members Only Section unless noted here: __________________
Programs you would like to see and/or your interest in volunteering for organizational activities:
_________________________________________________________________________________________
_________________________________________________________________________________________
Name of Person Who Referred You to HACOC: _____________________________________________
Amount Paid: __________Date: ___/___/ ___ Ck# _______ or ________
By: ___________________________________
www.houstonareacontinuityofcare.org
Office Ph: (___)_____________ Cell Ph: ____________________________ FAX: ________________
Employer: ___________________________________________________________________________
Title:_______________________________E-mail: __________________________________________
Mailing Address: ______________________________________________________________________
Membership Directory description: (25 words or less.) Or email to: barbaralspan@gmail.com
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
Please Select One of the Following Options:
_______ Enclosed is my check for $55 - Individual Membership (NON TRANSFERABLE)
_______ Enclosed is my Company's check for $200 – Corporate Membership (WAIT LIST FOR 2010)
Name of Company______________________________________________________________________
_______________________________________________________________________________________
Name of Alternate Member: _____________________________________ ________________________
_______ Enclosed is my company's check for $125 - Group Membership
Name of Company_______________________________________________________________________
Individual Membership Benefits ($55)
1. Monthly Networking opportunity
2. Cultivate professional relationships
3. Member–only access to HACOC website
4. Exposure to industry updates and education
5. Listing in the web HACOC Directory
6. Accessibility to Discretionary Fund
7. Opportunity to display marketing materials at meetings on display table only.
8. Participation in Annual Fundraiser if (Applicable)
9. Reduced Cost for monthly meeting and lunch ($25 members / $35 non-members)
Corporate Membership offers the following advantages ($200)
1. Membership is the company, not a specific employee (more versatile.)
2. Two (2) company employees per meeting are entitled to member lunch rates ($25-member vs. $35
non-member per lunch meeting, a $10 per person per lunch savings.)
3. Corporate Sponsorship only - company will "Lunch Sponsor" at one meeting during the year and
be entitled to an "infomercial" as part of the regular program at the meeting and arrange for
program. Also included is the logo on the HACOC website and on the meeting announcement for
the month.
4. "Group Membership" entitles company to be a "Dessert Sponsor" at one chosen meeting and
display signage and brochures on the dessert table $125 Two Members>
Please return this form and check to:
Houston Area Continuity of Care
P.O. Box 301128
Houston, TX 77230-1128, or
Pay by cash or check at the next meeting.
APPLICANT SIGNATURE:
__________________________________________________________________
Consent to be listed on the website in Members Only Section unless noted here: __________________
Programs you would like to see and/or your interest in volunteering for organizational activities:
_________________________________________________________________________________________
_________________________________________________________________________________________
Name of Person Who Referred You to HACOC: _____________________________________________
Amount Paid: __________Date: ___/___/ ___ Ck# _______ or ________
By: ___________________________________
www.houstonareacontinuityofcare.org
2010 MEMBERSHIP APPLICATION / RENEWAL FORM Houston Area Continuity of Care P.O. Box 301128 Houston TX 77230-1128 |
HACOC Mission Statement:
To encourage the mutual sharing of information among health care professionals involved in the continuity of
care and discharge planning. Through mutual support, ongoing education, and open communication, members
stay abreast of industry changes and standards.
Individual Membership Benefits ($55)
· Monthly Networking opportunity
· Cultivate professional relationships
· Member–only access to HACOC website
· Exposure to industry updates and education
· Listing in the web HACOC Directory
· Accessibility to Discretionary Fund
· Opportunity to display marketing materials at meetings on display table only.
· Participation in Annual Fundraiser if (Applicable)
· Reduced Cost for monthly meeting and lunch ($25 members / $35 non-members)
Group Membership Benefits ($125)
· In addition to the above
· Membership is the company not a specific employee
· Two Company employees per meeting are entitled to member lunch rates
· Company employees can be different- (proof of employment required e.g. Business card)
· Website Visibility
· Desert Table Sponsorship one meeting out of the year. (Display your Company name and
brochures on the Desert Table. Meeting recognition and web announcements.)
Corporate Membership Benefits ($200) (Not available 2010 as of 2/10/2010. Waitlist only)
· In addition to the above
· Corporate logo on the website.
· Recognition on Promotional materials.
· Four corporate representatives may attend monthly meetings at the membership rate.
· Corporate sponsors host one annual meeting at which time they may display info at all tables and at check-
in table if wish.
· At the sponsored meeting, a short (up to 10 minutes) presentation about the product or service may be
incorporated as the introduction to the luncheon speaker.
· Provide the monthly speaker on the month of sponsorship. (Please note: selected speaker should be of
interest to the membership and approved two months prior to meeting. Speaker may not mention company
during the talk.)
For more info: www.houstonareacontinuityofcare.org
2010 Board Members for HACOC:
President: Honey Leveen, Long Term Care Insurance
Vice-President: Kate Dowlen, Senior Guidance Directory
Treasurer: Barbara Spangenberg, McCulloch & Associates
Secretary: Donna Moran, Grace Care of Katy; Membership: Carolyn DeWitt, Colonial Oaks Discretionary
Fund: Dixie Turner, Professional Caretakers
Member at Large: Doris Brand, Cameo Caregivers; Member at Large: Cheryl Thomas, RN
Past President: Christy Medlin, HCR Manor Care
Past Treasurer: Dana Little, Cameo Caregivers